Chronic Hypertension is used to describe the condition of long term high blood pressure .The usual cause is ‘ essential hypertension ‘, meaning an inherited condition with no underlying pathology .

The threshold for diagnosing Hypertension in pregnancy is 140/90 mm Hg . In second half of pregnancy cut off is 170 / 110 mm Hg . However 170 / 110 or higher is considered to be severe Hypertension ( Davey & MacGillivray 1988 ) .

Thus hypertension in pregnancy has three possible aetiologies :

1) It may be caused by pregnancy itself

2) It may be long term problem present before pregnancy began

3) It may be a new medical problem by chance coinciding with pregnancy

PRE-ECLAMPSIA :

Pre-eclampsia , pre – eclamptic toxaemia ( PET) or gestosis are roughly synonymous terms, a common syndrome that becomes detectable in the second half of pregnancy ( although origins may lie in the first half ) and which is defined in terms of the new development of hypertension and proteinuria . It is common , dangerous to both mother and baby .

The cause of pre-eclampsia is not yet known but must lie within the gravid uterus . Hence , although pre – eclampsia is conventionally defined as hypertension is not primarily a hypertensive disease . The signs of pre-eclampsia are therefore best considered as secondary to a uteroplacental disorder affecting specific maternal target systems . The targets include the maternal cardiovascular , renal , coagulation and hepatic systems .

Definition of Pre-eclampsia as accepted by the International Society for the Study of Hypertension ( Davey & MacGillivray 1988 ) is :

Proteinuria : 24 hr urine collection : ≥ 300 mg protein ;

Pre – eclampsia : New hypertension and new proteinuria developing after 20 weeks gestational age and regressing remotely after delivery .

RISK FACTORS FOR PRE-ECLAMPSIA :

MATERNAL FACTORS :

Primigravidity

Primipaternity ( There is partner specificity about the occurance of pre-eclampsia . Hence , it is not simply the first pregnancy that is an important risk factor but the first by the current partner) .

Short period of co habitation ( Stable co habitation with a single partner seems to reduce the risk of pre – eclampsia in the first pregnancy by the partner ) .

The principles of management are :

Screening of the symptomless patient , diagnosis and well timed delivery .

Symptomless proteinuric pre- eclampsia demands urgent admission on the day of diagnosis .

Pre – eclampsia without proteinuria , which has been confirmed by biochemical testing ( eg hyperuricaemia ) is usually best managed in a day assessment unit where frequent detailed checks are routine .

Mild hypertension with no other complicating factor can be managed conservatively from routine clinics .

AYURVEDA :

Though there is no direct mention of PIH in Ayurveda , but some symptoms as complication of pregnancy have been described . It can be termed as Garbhajanya Vishamayataa .The main symptoms are :

Shopha ( Oedema )

Paad Shotha ( Pedal oedema )

Mutra alpata ( Oliguria )

Aakshepa ( Convulsions )

Sangyanasha ( Coma )

MANAGEMENT :

In PIH , Ayurveda helps in limiting the maternal and fetal complications . Herbs are helpful as a supportive treatment along with the modern medicine under supervision .